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Image of a dog's cervical spine.

Once your dog has been diagnosed with cervical intervertebral disc disease, your veterinarian will discuss treatment options with you.  

Advanced Diagnostic Imaging

If your dog has been referred for possible surgery, the surgeon will review the history and prior treatments and examine your dog. After your dog’s evaluation has been completed and surgery is recommended as the next step, the surgeon will recommend advanced diagnostic imaging. Such imaging will help pinpoint the cause and location of the problem and guide the surgical treatment.

There are several techniques used for advanced diagnostic imaging:

• X-rays: If not already done by your veterinarian, and if the surgeon is concerned that there could be something other than IVDH (Intervertebral Disc Herniation) as the cause for your dog’s signs, she or he may take standard X-rays to start.
• Myelogram: This is an X-ray technique that adds more information than plain X-rays. under general anesthesia, an area over the back of the neck or back of the lumbar (lower back) region is shaved and cleaned, and a special needle is inserted through the skin, between the vertebrae, and into the membranes that surround the spinal cord (this is called a “spinal tap”). There is fluid (cerebrospinal fluid, called CSF) between those membranes and the spinal cord. Some of this fluid may be collected and analyzed in a laboratory, and then a special contrast medium (“dye”) is injected into the spinal fluid. X-rays of the neck follow this. The contrast medium in the spinal fluid creates an outline of the spinal cord, and any spinal cord deformity can then be seen. Depending on the pattern of the deformity, the surgeon can conclude whether it is from a disc herniation or some other cause. Myelography with standard X-rays is an older technique that is less commonly used nowadays.
• Magnetic resonance imaging (MRI): This procedure requires general anesthesia but is noninvasive; no spinal tap or injection into the spinal fluid is needed. MRI usually provides exquisite detail of the spinal cord and discs and can give a very clear idea as to the cause of the signs (IVDH vs. something else). It is considered the “gold standard” for spinal imaging in both humans and animals.
• Computed tomography (CT; CAT scan): This procedure may only require brief sedation instead of general anesthesia. The images are not as detailed as those from an MRI, but they are usually adequate to diagnose disc herniations. 
• Combining CT with a myelogram: Can enhance the quality of CT images for spinal problems. CT/myelogram combinations are usually highly diagnostic, more widely available than MRI, and less costly than MRI. The referred surgeon will advise which of the above options are available and give their recommendations. Surgery is often done immediately after the diagnostic imaging.

Note that none of these imaging types are generally recommended unless there is an intention to pursue surgery for treatment since knowing the specific cause and location of a problem won’t alter the non-surgical options available. 

Conservative Treatment

Treatment usually begins with non-surgical interventions in dogs where pain, or pain plus a root signature, is the only sign, and the presumption is that signs are due to IVDH. The key to successful conservative treatment is restricting your dog’s activity.

Resting a herniated disc is like resting a sprain. In dogs, this means strict crate rest. Rest helps decrease inflammation and allows the body to heal the injury. Activity should be limited to bathroom breaks on a leash with no excessive movement.

Crate rest will probably be recommended for at least two to four weeks, even if you see improvement in your dog before the end of the prescribed rest period. Along with limited activity, your veterinarian will likely prescribe one or more medications. These include analgesics (painkillers), anti-inflammatory drugs (corticosteroids or non-steroidal medications), muscle relaxants, and sedatives.

Because these drugs can help control symptoms but do not specifically treat the underlying cause, improving while on medication does not eliminate the need to continue crate rest for the prescribed period, especially as your dog begins to feel better and wants to move more.

The finding of neurologic deficits and not just pain points to some degree of spinal cord involvement. If neurologic signs are mild, it may still be appropriate to follow a conservative course of treatment. However, your dog should be watched closely for evidence of a worsening condition, especially if they have been confined appropriately and has had medical treatment. Surgery is usually recommended if signs are more extreme (such as severe incoordination and weakness).

Mild signs such as pain alone do not always relate to the amount of herniation by the disc or the degree of spinal cord compression. Dogs with only mild signs may have very large disc protrusions or extrusions. These dogs may not respond to conservative treatment or may relapse. If this is the case with your dog, your veterinarian may feel surgical referral is more appropriate.

Surgical Management

The choice to pursue surgery for IVDH is based on the severity and progression of signs, your dog’s past history (have there been previous bouts of similar signs?), and response (or lack thereof) to non-surgical treatments. 

A scale of the severity of the signs can be created, starting with neck pain alone and moving to paralysis. While there is no defined cut-off point for trying non-surgical treatment, it is generally true that the chances for recovery without surgery decrease the further down the scale, and surgery is usually recommended if a patient is non-ambulatory (unable to walk). 

Even milder signs may justify surgery if they do not resolve with appropriate medical treatment or relapse often.

Surgical Procedures

The goals and capabilities of surgery for IVDH are surprisingly quite limited and straightforward: To decompress (take the pressure off) the spinal cord and nerve roots. Surgery generally cannot “fix” any internal spinal cord injuries. It is hoped that the signs will be eliminated quickly with surgery and that better blood flow to the spinal cord will result in healing and recovery of lost functions in dogs with more severe signs.

There are two basic approaches for neck surgery:

• ventral (‘anterior’ in humans):

The most common approach is to make an incision in the front of the throat and approach the spine from the bottom. This is less traumatic to the dog than you might think since muscles and organs in the neck can be retracted (moved away) rather than cut to reach the spine. 

Specialized cutting instruments are used to create a small slit-like window (called a ventral slot) through the bottom of the disc and the adjacent vertebrae (spinal bones), allowing the surgeon to remove the herniated disc without harming the spinal cord.

• dorsal ("posterior" in humans):

The dorsal approach is through the back of the neck. This is done when the disc has herniated laterally (off to one side) or where the surgeon feels the more limited ventral slot approach will be inadequate for accomplishing decompression. The roof of each vertebra is called the “lamina,” and opening the bone here is termed a laminectomy or hemilaminectomy (just one side of the bony roof). 

Regardless of the surgical approach, decompression is only achieved once the surgeon removes the herniated disc and alleviates all spinal cord and nerve root deformities.

Surgical Recovery and Prognosis

Patients that have undergone spinal cord decompression surgery have a varying prognosis. Factors that influence outcome include the severity of the spinal cord injury, duration of the compression, completeness of the decompressive procedure, and severity of signs preceding surgery. 

Even with an MRI, the degree of internal spinal cord injury associated with disc herniation cannot be fully known. Spinal cord injury is estimated based on the severity of signs, but some dogs do much better than hoped, and others unfortunately less well than expected. 

The time needed for recovery also varies. Some dogs may show immediate improvement, while others may not show signs of recovery for two to three weeks post-surgery.

Pain is often improved promptly after surgery due to the nerve roots' decompression. Usually, recovery in paralyzed dogs follows a standard pattern, depending on the severity of the injury.

Once limb movement returns, bladder and bowel control are expected to follow. However, until then, and until it is decided that the dog can voluntarily control going to the bathroom, a critically important part of patient care is bladder management to ensure the bladder is being emptied regularly and frequently. This may initially require in-hospital management, but eventually, owners are taught how to meet this need at home.

Many facilities offer formal physical/rehabilitation therapy staffed by veterinarians and nurses certified in these fields or physical therapists from the human field working under a veterinarian’s supervision. Patients recovering from spinal surgery may likely be referred to such a facility. While there may be core exercises for rehabilitating dogs after such surgery, programs are usually tailored to individual patient requirements and tolerance. 

Please see: Cervical IVDD (Intervertebral Disc Disease) in Dogs - Background and Signs